Cancer patients are at much greater risk of bankruptcy than people without cancer, according to a large new study. And while the new health care law promises insurance coverage to more than 30 million Americans who lack it now, the high cost of cancer care can push many patients, especially younger women, into financial trouble, experts say.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

“We need to look into why this happening and see if there is something we as a society can do to reduce that risk,” says Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research in Seattle and lead author of the study published Wednesday in the journal Health Affairs.

Ramsey and his colleagues matched 197,840 adults from a western Washington cancer registry with an equal number of cancer-free adults by age, zip code and sex. They then determined who had filed for bankruptcy, using court records.

The researchers found that 4,408 of those diagnosed with cancer between 1995 and 2009 had filed for bankruptcy, compared to 2,291 of those without cancer. Overall, cancer patients were 2.5 times as likely as others to file for bankruptcy.

Non-white females were the most likely to file, while patients 65 or older were the least likely -- possibly because they were covered by Medicare and eligible for Social Security.

Bankruptcy rates among the younger groups were up to 10 times that of the older patients. “People who have fewer assets, less income and less generous insurance because of entry level jobs or no insurance are more vulnerable to severe financial distress,” Ramsey says.

The highest rates of bankruptcy were among those with thyroid cancer, which mostly affects younger women. The lowest were in men with prostate cancer, which typically strikes at an older age.

“They used an ingenious way of getting this information,” says Dr. David Himmelstein, an internist and professor of public health at the City University of New York. And though the researchers don’t have information on the cancer patients’ insurance coverage, “previous studies tell us that about three-quarters of people who say that illness was a major factor in their bankruptcy had private health insurance, at least when they first got sick,” Himmelstein says.

That rings true for Janet Literski, 57, who had purchased health insurance as an independent contractor working in sales. When she was diagnosed with non-Hodgkin’s lymphoma in 2008 Literski discovered her insurance covered only part of her surgical costs and none of her diagnostic tests. Then there were co-payments and deductibles. By the time she was diagnosed with pancreatic cancer two years later, she was about $150,000 in medical debt.

In 2011, no longer able to work, Literski and her disabled husband filed for bankruptcy. “It was a gut wrenching decision because you feel like a personal failure, and that makes me angry because I had tried to do everything right,” Literski says. “I had health insurance, I was working.”

Literski is now covered by Medicaid and receives disability payments and though she hasn’t been told she’s in remission, she says she is “healthy enough.”

Steven Wieckowski, a financial counselor with the national nonprofit GreenPath Debt Solutions, advises newly diagnosed cancer patients to assess how the diagnosis might impact their income; to review their health insurance policy coverages; to determine whether they’re signed up for a disability plan at work; to prioritize their bills, putting housing, utilities, food, car payments and child care at the top of the list; and to reach out to credit card companies and the holders of student loans to ask for deferral.

“When cancer strikes, a lot of folks feel so out of control,” Wieckowski says. These steps can put people back into control of this portion of their life.”

Ramsey believes the 2010 Patient Protection and Affordable Care Act, which will extend health insurance coverage to more than 30 million Americans, could reduce bankruptcy rates.

But Himmelstein, who examined Massachusetts bankruptcy rates two years after the state implemented a health reform law similar to the federal law, isn’t hopeful.

“We found little or no impact, basically because the insurance coverage people got was so skimpy that it offered inadequate financial protection,” he says.